Required required for all Digital Bridge Initial Implementations
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1 Digital Bridge ecr Functional Requirements Statements January 24, 2017 To be read with accompanying ecr Task Flow diagram and process notes documents. ation available at digitalbridge.us Task Reqt ID ENTITY / Health Care Health Care Begin Patient Visit Begin patient visit None Outside scope of ecr N/A Health Care Health Care Review, Deliver and Patient Care Review, Deliver and Patient Care Accept structured information, including patient and clinical information that is either in coded values or can be translated by the EHR to coded values. This pre-defined process is unique to each patient and provider encounter but could include documenting symptoms, history, diagnoses, ordering labs, performing procedures, prescribing medications, etc Health Care Health Care Initiated Initiated Provide ability for user to manually trigger an electronic initial case report HL7 CDA R2 Implementation Guide: Case, Release 2 - US Realm - the
2 ment/standards/product_ brief.cfm?product_id= Health Care Health Care Initiated Initiated Indicate, in eicr, that report was manually initiated. addition of structured clinical information (that is either in coded values or can be translated by the EHR to coded values) for inclusion in electronic initial case report. See above See above Health Care Health Care Health Care Compare to Trigger Codes Compare to Trigger Codes Compare to Trigger Codes Compare patient information (i.e. EHR coded events) to public health trigger criteria (i.e. RCTC) by examining the following areas: Observation Diagnosis Lab order Lab result Procedure result Rx, medication order Medication administration Compare iteratively the patient data with trigger criteria on an event-based or time-based basis able Conditions Trigger Code (RCTC) table (available at able Conditions Trigger Code (RCTC) table (available at Digital Bridge initiative will collaborate with implementing sites on this function with respect to timing of comparison, clinical workflow, and public health reporting timeframes. Digital Bridge initiative will collaborate with implementing sites on this function with respect to timing of comparison, clinical workflow, and public health reporting timeframes.
3 Health Care Match? Health Care Health Care Generate public health case report HL7 CDA R2 Implementation Guide: Case, Release 2 - US Realm - the Health Care Health Care Health Care Check for completion of mandatory fields Ability to send electronic initial case report (eicr) at any point in required time frame clinical encounter if mandatory data are available Have the ability to track information relevant to a specific public health case as information is shared between Health Care and ment/standards/product_ brief.cfm?product_id=436 See above See above Digital Bridge initiative will collaborate with implementing sites on this function with respect to timing of comparison, clinical workflow, and public health reporting timeframes. Digital Bridge initiative will collaborate with implementing sites on this function with respect to timing of comparison, clinical workflow, and public health reporting timeframes.
4 Health Care Health Care Health Care to Decision to Decision to Decision public health case report to decision support intermediary Provide ability for Health Care to configure EHR to send eicr to an electronic endpoint responsible for routing to Decision Decision will be the APHL Informatics Messaging Service (AIMS) grams/informatics/pages/ aims_platform.aspx Digital Bridge initiative will collaborate with implementing sites on agreements needed to connect to AIMS. initial case report may travel to another intermediary (e.g., HIE) before reaching AIMS. initial case report may travel to another intermediary (e.g., HIE) before reaching AIMS Health Care Health Care Health Care Health Care Health Care Related to eicr confirmation of receipt of eicr by Decision the information contained within the eicr that is sent to the Decision request for information missing from eicr Notify provider (or associated support personnel) of request This information will be provided by Decision This request will be provided by Decision
5 Health Care Health Care Health Care Health Care Health Care for information missing from eicr provision of information missing from eicr determination of public health reportability which public health agency (or agencies) case report was forwarded to confirmation of receipt of eicr by public health agency (or agencies) Notify provider (or associated support personnel) of request for follow up action This information will be provided by Decision This information will be provided by Decision This information will be provided by Decision Follow up actions could include: Immediate reporting via telephone to ; Request for supplemental information on case; Health Care Health Care Health Care Provide ability to queue and prioritize notifications and requests for follow up action received by Decision actions taken by provider (or associated support personnel) to satisfy request for follow up action any intervention guidelines provided by Public
6 Health Health Care Health Care Decision Decision request for information supplemental to electronic case report provision of information supplemental to electronic case report public health case report(s) from Health Care,, Decision will be the APHL Informatics Messaging Service (AIMS) Decision Decision Decision Decision Valid Message/? Valid Message/? Provide an acknowledgement to the Health Care that a message was successfully receiver Provide an acknowledgement to the Health Care that the received message data is correctly formed or malformed whether or not eicr has correct structure and content grams/informatics/pages/ aims_platform.aspx HL7 CDA R2 Implementation Guide: Case, Release 2 - US Realm - the
7 ment/standards/product_ brief.cfm?product_id= Decision Decision Decision Decision Decision Decision Decision, Error Message, Error Message, Error Message, Error Message Create and send message indicating the eicr was malformed and could not be processed by Decision Create and send message indicating any missing data elements from eicr Forward malformed eicrs for dispositioning by Decision according to public health jurisdictionspecific rules. Consume jurisdiction-specific public health criteria for use in determining Use jurisdiction-specific public health criteria to make an automated determination if case report does not meet reporting criteria and should not be sent to meets reporting criteria and should be able Conditions Knowledge Management System (RCKMS) able Conditions Knowledge Management System (RCKMS) p/rckms Jurisdiction-specific reporting criteria will be provided by public health agencies through use of able Conditions Knowledge Management System (RCKMS). Jurisdiction-specific reporting criteria will be provided by public health agencies through use of able Conditions Knowledge Management System (RCKMS).
8 sent to Decision Decision Use jurisdiction-specific public health criteria to make an automated determination if case report does not meet reporting criteria and should still be sent to represents an indeterminate case and should be sent to determination on public health reportability. able Conditions Knowledge Management System (RCKMS) p/rckms able Conditions Knowledge Management System (RCKMS) p/rckms Some public health agencies may set their reporting criteria to receive non-cases (e.g. negative lab result, no diagnosis) or indeterminate cases (i.e. insufficient data to determine reportability) if legally permitted. Possible determinations include: 1) does not meet reporting criteria and should not be sent to 2) meets reporting criteria and should be sent to 3) does not meet reporting criteria and should still be sent to 4) indeterminate case and should be sent to Public Health 5) indeterminate case due to missing information Specific public health agencies should be referenced in above
9 determinations as appropriate Decision Decision to? to? If determination is that case is reportable to public health, determine which public health agency(ies) case should be sent to (see below) Decision Decision Routing (for eicr) Routing (for eicr) which (s) should receive the electronic case report case report may be routed to more than one. Criteria supports following options made by jurisdictions: to jurisdiction if care was provided in jurisdiction to jurisdiction if patient is a resident to jurisdiction if lab was in jurisdiction Decision Decision Need? Need? Based on public health jurisdiction-specific requirements, provide ability to,
10 Decision Decision Decision Decision Decision Request Request Request Request Request request supplemental information in addition to data provided in eicr. Request supplemental information in addition to data provided in eicr. a request for diseasespecific information to Health Care a request for incidentspecific information to Health Care a request for case-specific information to Health Care,,,, Decision Decision Decision Decision Provide ability to communicate reportability status of an eicr or group of eicrs. Provide ability to communicate requested Health Care actions related to eicr or group of eicrs. Provide ability to communicate which potential case reports were reportable and sent to
11 Decision Decision Decision Decision Decision Decision not reportable and not sent to Provide ability to communicate which the potential case reports were not reportable and still sent to of indeterminate status and still sent to Provide ability to communicate that reportability could not be determined because eicr was missing information and specify the information that is missing Provide ability to include links to external resources (e.g. treatment guidelines, intervention protocols) Provide ability to embed materials/ documents within response Provide the ability to request supplemental data Provide the ability to include a technical acknowledgement that the PHA successfully received the ecr, The Governance body strongly encourages all Initial Implementation Sites to send this acknowledgement message Decision
12 Decision Decision Decision to Health Care. to. technical acknowledgement that the PHA successfully received the ecr to the HCP The Governance body strongly encourages all Initial Implementation Sites to send this acknowledgement message Decision Decision Use the predefined transport to deliver the case report to each appropriate local Decision will be the APHL Informatics Messaging Service (AIMS) grams/informatics/pages/ aims_platform.aspx Decision Decision Disposition eicr Disposition eicr Disposition Initial Case according to public health jurisdictionspecific dispositioning rules. Public health jurisdictionspecific dispositioning rules will prescribe how long an eicr can be retained by Decision
13 before being destroyed Case public health case report via predefined transport HL7 CDA R2 Implementation Guide: Case, Release 2 - US Realm - the Create technical acknowledgement of receipt of ecr ment/standards/product_ brief.cfm?product_id=436 The Governance body strongly encourages all Initial Implementation Sites to send this acknowledgement message Need? Need? Need? Based on public health jurisdiction-specific requirements, provide ability to request supplemental information in addition to data provided in eicr. technical acknowledgement of ecr receipt to DSI, The Governance body strongly encourages all Initial Implementation Sites to send this acknowledgement message
14 Provide the ability for Public Health to receive the same s sent to a Health Care Health Care Health Care Health Care Provide (if requested) Provide (if requested) Provide (if requested) Extract structured data from an electronic health record associated with a case Have the ability to enter unstructured data,, Health Care Health Care Create Create Properly populate and format a message with supplemental/modified information so that it can be routed and associated with the appropriate case and (if applicable) specific that requested the supplemental/modified information., Health Care
15 Health Care Provide ability to send supplemental information to Decision., Decision Decision Routing (for supplemental information) Routing (for supplemental information) Route the supplemental information to the appropriate PHA(s) based on retained knowledge regarding 1. the PHA(S) that requested the supplementary information, and 2. predefined transport, Provide the ability for Public Health to receive information into the "Manage Case " pre-defined process,
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